6. GLOBAL STATISTICS
6/21/2019Dr. Mohd N Khan
6In India 2017, a study was conducted among 151 patients,
around 49% of patients reported problems in
using glaucoma medications, with 16% of them reporting total
non-compliance. 35% patients demonstrated improper drop
administration technique. (Journal of current ophthalmology.
2018;30(2):125-9)
In Saudi Arabia revealed that noncompliance was detected in
19.4% of the glaucoma patients. (Journal of ocular
pharmacology and therapeutics : the official journal of the
Association for Ocular Pharmacology and Therapeutics.
2016;32(1):50-4.)
7. 6/21/2019Dr. Mohd N Khan
7
In Egypt, 440 patients were enrolled . The number of
patients found to be noncompliant was 236 patients
(53.6%), whereas 204 patients (46.4%) were found to be
compliant. J Ophthalmol. 2015; 2015: 234157
Lu et al, found that rates of nonadherence ranged
between 23% and 60% over 12 months and rates of
non-persistence ranged between 30% and 95% at 1
year. (Am J Ophthalmol. 2010 Oct; 150(4):569-574.e9)
8. Barriers of compliance
6/21/2019Dr. Mohd N Khan
8 Patients related :
poor education
lack of motivation
forgetfulness
drop application
age differences
mental status
Medications related : availability, cost, multi-
dose regime, side effects
Social and religious : fasting
11. Difference between Compliance and Adherence
6/21/2019Dr. Mohd N Khan
11compliance suggests that the provider has set a
rule and the patient is expected to follow it.
According to a recent British Journal of
Pharmacology article, the term compliance comes
from “the Latin word complire, meaning to fill up
and to fulfil a promise. The patient is promising to
take their medication and they aren’t owning that
process.
Adherence on the other hand comes from “the
Latin word adhaerere, which means to keep close
or remain constant. It is through the patient’s
own choice and they’re actively making a decision
to stay on track.
12. 6/21/2019Dr. Mohd N Khan
12
Persistence it is the total time for which the
patient correctly takes the appropriate medication.
Persistency is thought in part to represent the
patient’s satisfaction with the agent’s tolerability
as well as the physician’s satisfaction with the
agent’s clinical efficacy.
13. Adherence significance
6/21/2019Dr. Mohd N Khan
13
Patient adherence with medication improves in 5
days before and after their appointment with their
physician.
This behaviour pattern with effects of diurnal
variation of therapy must be taken into account
when treating patients who have progressive
glaucomatous damage but are at a seemingly
“safe” pressure.
The lack of proper adherence to a medication may
lead to unnecessarily changing the treatment
regimen or the addition of more medication or
perhaps glaucoma surgery.
14. COMPONENTS OF MEDICATION
ADHERENCE
6/21/2019Dr. Mohd N Khan
14
Proper adherence involves at least 4 steps:
1) patients must obtain the medication
2) successfully instil the drop into the eye
3) use at the appropriate time
4) do so each day
15. Adherence evaluation
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15
Direct methods :
Observing the patient take the medication
Measuring concentration of the drug
Metabolite in blood or urine.
Indirect methods :
Patient self-reporting
Evaluating pharmacy refill rates
Measuring the amount of medication in the
bottle at each visit
Electronic medication monitors
Measuring clinical response
Using a patient medication diary
26. Proper way to apply eye
drops
6/21/2019Dr. Mohd N Khan
26
Tilt head back
Bring the nozzle of the bottle near to the eye
Avoid the nozzle tip from touching the eye
Instil one drop in conjunctival sac then close
the eyes for 3 to 5 minutes
Nasolacrimal occlusion technique.
Important : keep their eyes closed for a
few minutes after instilling eye drops to
increase drug effect
